Easing the pain of perimenopause

Perimenopause is a natural transitional phase that occurs before menopause, marking the beginning of significant hormonal changes in a woman's body. This phase often begins in a woman's late 30s or early 40s and can last for several years. While it is a natural part of ageing, perimenopause can bring about a variety of symptoms that may affect your quality of life.

In this guide, we’ll explore the symptoms of perimenopause, effective ways to manage them, and the treatments available to help ease the discomfort.

Key Takeaways

What is Perimenopause?

Perimenopause is the phase before menopause when hormone levels start to drop, usually lasting 2 to 10 years. Symptoms can include hot flashes, mood swings, irregular periods, and insomnia, as the body transitions out of its reproductive years.

Managing Symptoms Naturally

Lifestyle changes like eating a balanced diet, regular exercise, staying hydrated, and managing stress can help ease symptoms. Supplements such as calcium, vitamin D, magnesium, and phytoestrogens (found in soy or flaxseed) can also provide relief.

Medical Treatments for Severe Symptoms

Hormone Replacement Therapy (HRT) is highly effective for severe symptoms, while non-hormonal options like gabapentin or antidepressants are available for those who prefer alternatives. Always consult a doctor to determine the best approach for your symptoms and needs.

Understanding Perimenopause

What is Perimenopause?

Perimenopause, also referred to as pre-menopause, is the phase leading up to menopause. During this time, the ovaries gradually reduce their production of oestrogen, the hormone responsible for regulating the menstrual cycle. This phase typically lasts between 2 to 10 years and ends one year after a woman’s last menstrual period.

Perimenopause is not a disease but a natural process signalling the end of a woman’s reproductive years. Each woman experiences this phase differently, with varying symptoms and intensities.

Recognising the Symptoms of Perimenopause

Common Symptoms

The hormonal fluctuations of perimenopause can cause a wide range of symptoms, including:

• Hot flashes and night sweats: Sudden waves of heat that can disrupt sleep and daily activities.

• Irregular periods: Changes in cycle length, heavier or lighter flows, or skipped periods.

• Mood swings and depression: Emotional changes influenced by hormonal shifts.

• Insomnia: Difficulty falling or staying asleep.

• Vaginal dryness: Reduced oestrogen levels leading to discomfort during intimacy.

• Hair changes: Thinning hair or increased facial hair.

• Fatigue: Persistent tiredness due to disrupted sleep or hormonal changes.

• Aching muscles and joints: Hormonal changes affecting muscle and joint health.

• Memory issues: Difficulty concentrating or occasional forgetfulness.

Less Common Symptoms

• Tingling sensations: A prickling feeling in the skin.

• Digestive issues: Nausea, bloating, or flatulence.

• Changes in nails: Softer, brittle nails.

• Skin changes: Flaky, itchy skin.

• Heart palpitations: Irregular or racing heartbeat.

Managing Perimenopause Symptoms

Lifestyle Changes

Adopting a healthy lifestyle can significantly ease perimenopause symptoms:

• Balanced diet: Reduce carbohydrate intake and incorporate omega-3 and omega-6 fatty acids. Include plenty of fresh fruits, vegetables, and whole grains.

• Regular exercise: Physical activity improves blood circulation, boosts mood, and supports hormonal balance. A simple morning walk can make a difference.

• Adequate hydration: Drink at least 8 glasses of water daily to maintain hydration and skin health.

• Quality sleep: Establish a consistent bedtime routine to combat insomnia.

• Stress management: Engage in hobbies, mindfulness practices, or yoga to reduce stress.

Supplements

• Calcium and Vitamin D: Support bone health and reduce the risk of osteoporosis.

• Magnesium: Helps with muscle relaxation and mood regulation.

• Vitamin E: May alleviate hot flashes and night sweats.

• Phytoestrogens: Plant-based compounds found in soy, flaxseed, and supplements to mimic oestrogen and relieve symptoms.

Medical Treatments for Perimenopause

Hormone Replacement Therapy (HRT)

HRT is an effective treatment for alleviating severe symptoms of perimenopause. It replenishes declining hormone levels and can be tailored to individual needs. Common HRT options include:

• Oestrogen-only medications: Such as Evorel and Elleste Solo, suitable for women who have had a hysterectomy.

• Combined HRT: Includes both oestrogen and progesterone, such as Elleste Duet and Premarin.

HRT can also reduce the risk of osteoporosis, improve mood, and relieve hot flashes. Always consult with a healthcare provider before starting HRT to understand the benefits and risks.

Non-Hormonal Medications

For women who prefer not to use hormones, other treatments include:

• Gabapentin: Often prescribed for migraines, it can also help with hot flashes.

• Antidepressants: Such as Amitriptyline, to manage mood swings and depression.

Addressing Specific Symptoms

Irregular Periods

• Progestin or ibuprofen: Can reduce heavy flow.

• Contraceptive pills or IUDs: Help regulate cycles and alleviate symptoms.

• Surgical options: Such as hysterectomy or endometrial ablation for severe cases.

Hot Flashes and Night Sweats

• Black cohosh: A natural supplement shown to relieve these symptoms.

• Soy-based foods: Tofu, soy milk, and miso can mimic oestrogen’s effects.

• Cooling clothing: Choose breathable cotton fabrics to stay comfortable.

Mood Swings and Depression

• Vitamin B complex and magnesium: Natural mood stabilisers.

• St John’s Wort: A herbal remedy for mild depression.

When to Consult a Doctor

If lifestyle changes and over-the-counter remedies do not relieve your symptoms, it’s essential to consult with a healthcare provider. They can recommend personalised treatments, including medications or alternative therapies.

Final Thoughts

Perimenopause is a challenging but manageable phase of life. By understanding your symptoms and making thoughtful lifestyle adjustments, you can ease discomfort and maintain your well-being. Whether through natural supplements, HRT, or other medical treatments, there are options available to help you navigate this transition with confidence. Always consult a doctor to determine the best approach for your unique needs.

Medically Reviewed by:
Dr. Alexis Missick MBChB. MRCGP
GMC reference no: 7151419
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